Healthcare Provider Details

I. General information

NPI: 1013097195
Provider Name (Legal Business Name): NRV ORAL & MAXILLOFACIAL SURGERY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL PARK DR SE SUITE 1
BLACKSBURG VA
24060-6665
US

IV. Provider business mailing address

100 PROFESSIONAL PARK DR SE SUITE 1
BLACKSBURG VA
24060-6665
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-8777
  • Fax: 540-951-9642
Mailing address:
  • Phone: 540-951-8777
  • Fax: 540-951-9642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. CLINTON W HOWARD III
Title or Position: SURGEON
Credential: DMD
Phone: 540-951-8777